Background: Patients with chronic kidney disease (CKD) are at high risk of cardiovascular disease (CVD) and premature death. Insulin resistance (IR) is prevalent in CKD and is one of the most important nontraditional CV risk factors in CKD. We investigated the association between practical insulin sensitivity (IS) indices and the gold standard hyperinsulinemic euglycemic clamp (HEGC) among CKD (estimated GFR = 15-59ml/min) and non-CKD persons.

Methods: The relationship of insulin sensitivity in kidney disease (RISKD) study was a cross-sectional investigation involving 140 nondiabetic patients (52 CKD and 88 non-CKD). Insulin sensitivity was assessed by the HEGC-derived insulin sensitivity index (ISI), homeostatic model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), McAuley index, and leptin-adiponectin ratio (LAR). Spearman correlation (rs) and multivariable linear models were used to investigate the association between the practical indices and ISI.

Results: Compared to non-CKD controls, CKD patients had a higher prevalence of IR based on published cut-points for practical IS markers (HOMA-IR: 83% vs. 32%, p<0.0001; LAR: 60% vs. 46%, p<0.0001). HOMA-IR had the strongest correlation (rs = -0.59, p=0.002) with ISI in CKD patients while McAuley had the weakest correlation (rs = 0.50, p=0.0001). Conversely, in non-CKD controls, McAuley had the strongest correlation with ISI (rs = 0.72, p=0.0001). In multivariable models, sex, leptin, and eGFR were independently associated with ISI (p = 0.04, <0.001, and 0.03 respectively).

Conclusion: Patients with CKD had a higher prevalence of IR. While all IS indices showed significant correlations with clamp-derived ISI, HOMA-IR performed best in CKD patients while McAuley performed best in non-CKD persons. These data suggest that HOMA-IR is the preferred practical index to be used to assess insulin sensitivity in large cohort investigations involving CKD patients.


B.C. McMullan: None. E.A. Akwo: None. A.M. Hung: None.


U.S. Department of Veterans Affairs (I01CX000982 to A.M.H.)

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